@article{3166184,
    title = "Diabetes and onset of natural menopause: results from the European
Prospective Investigation into Cancer and Nutrition",
    author = "Brand, J. S. and Onland-Moret, N. C. and Eijkemans, M. J. C. and and Tjonneland, A. and Roswall, N. and Overvad, K. and Fagherazzi, G. and and Clavel-Chapelon, F. and Dossus, L. and Lukanova, A. and Grote, V. and and Bergmann, M. M. and Boeing, H. and Trichopoulou, A. and Tzivoglou, M. and and Trichopoulos, D. and Grioni, S. and Mattiello, A. and Masala, G. and and Tumino, R. and Vineis, P. and Bueno-De-Mesquita, H. B. and Weiderpass, and E. and Redondo, M. L. and Sanchez, M. J. and Huerta Castano, J. M. and and Arriola, L. and Ardanaz, E. and Duell, E. J. and Rolandsson, O. and and Franks, P. W. and Butt, S. and Nilsson, P. and Khaw, K. T. and Wareham, and N. and Travis, R. and Romieu, I. and Gunter, M. J. and Riboli, E. and and van der Schouw, Y. T.",
    journal = "MOLECULAR HUMAN REPRODUCTION",
    year = "2015",
    volume = "30",
    number = "6",
    pages = "1491-1498",
    publisher = "Oxford University Press",
    doi = "10.1093/humrep/dev054",
    keywords = "age at natural menopause; diabetes; time-dependent modeling; cox
proportional hazards analyses",
    abstract = "STUDY QUESTION: Do women who have diabetes before menopause have their
menopause at an earlier age compared with women without diabetes?
SUMMARY ANSWER: Although there was no overall association between
diabetes and age at menopause, our study suggests that early-onset
diabetes may accelerate menopause.
WHAT IS KNOWN ALREADY: Today, more women of childbearing age are being
diagnosed with diabetes, but little is known about the impact of
diabetes on reproductive health.
STUDY DESIGN, SIZE, DURATION: We investigated the impact of diabetes on
age at natural menopause (ANM) in 258 898 women from the European
Prospective Investigation into Cancer and Nutrition (EPIC), enrolled
between 1992 and 2000.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Determinant and outcome
information was obtained through questionnaires. Time-dependent Cox
regression analyses were used to estimate the associations of diabetes
and age at diabetes diagnosis with ANM, stratified by center and
adjusted for age, smoking, reproductive and diabetes risk factors and
with age from birth to menopause or censoring as the underlying time
scale.
MAIN RESULTS AND THE ROLE OF CHANCE: Overall, no association between
diabetes and ANM was found (hazard ratio (HR) = 0.94; 95% confidence
interval (CI) 0.89-1.01). However, women with diabetes before the age of
20 years had an earlier menopause (10-20 years: HR = 1.43; 95% CI
1.02-2.01, <10 years: HR = 1.59; 95% CI 1.03-2.43) compared with
non-diabetic women, whereas women with diabetes at age 50 years and
older had a later menopause (HR = 0.81; 95% CI 0.70-0.95). None of the
other age groups were associated with ANM.
LIMITATIONS, REASONS FOR CAUTION: Strengths of the study include the
large sample size and the broad set of potential confounders measured.
However, results may have been underestimated due to survival bias. We
cannot be sure about the sequence of the events in women with a late age
at diabetes, as both events then occur in a short period. We could not
distinguish between type 1 and type 2 diabetes.
WIDER IMPLICATIONS OF THE FINDINGS: Based on the literature, an
accelerating effect of early-onset diabetes on ANM might be plausible. A
delaying effect of late-onset diabetes on ANM has not been reported
before, and is not in agreement with recent studies suggesting the
opposite association."
}